The email conundrum

Incessant email, ugh.

The misuse of email is tremendous. Clive Owen at Wired writes, “Everyone complains about ‘e-mail overload’ — getting so much stupid corporate e-mail that you miss out on important messages.”

Two solutions.

The more practical and organizationally implementable makes email gamelike, from Wired:

Every employee is given virtual tokens — say, 100 a week, — that they can attach to e-mail they write. If you really want someone to read a message now, you attach a lot of tokens, and the message pops up higher in your correspondent’s Outlook inbox.

Turns out, it works. “When a work group at IBM tried [it], messages with 20 tokens attached were 52 percent more likely to be quickly opened than normal. E-mail overload ceased to be a problem.”

The second possibility is one that has been visited before, from Edward Gottesman at Prospect:

The time has come for a public sector remedy: a tax, perhaps no more than 2p, or 3c, on every email sent. Opponents will argue that collecting the tax is impossible or unfair. Yet the status quo is unworkable.

Has your organization thought about trying to reduce the amount of email? It needlessly keeps people behind their desks or inattentive on their Blackberrys/iPhones.

Households pay for health care

Remember, no matter how we “pay” for health care, the money always flows from households. Greg Mankiw makes an oft-ignored point when he writes that American business’ international competitiveness will not improve should they stop providing health care as a fringe benefit. He cites the CBO (pdf):

Replacing employment-based health care with a government-run system could reduce employers’ payments for their workers’ insurance, but the amount that they would have to pay in overall compensation would remain essentially unchanged. Even though changes to the health care system could have various effects on the supply of labor, the underlying amount of labor supplied at any given level of compensation would hardly be affected by a change in the health care system. As a result, cash wages and other forms of compensation would have to rise by roughly the amount of the reduction in health benefits for firms to be able to attract the same number and types of workers.

Compensation could take some time to adjust to its market-clearing level (the point at which supply and demand are equal). During that time, firms that formerly provided health benefits—especially firms that employ workers under multiyear contracts—could experience substantial reductions in labor costs, which would boost their profits temporarily. But those firms would experience no permanent change in their competitive status.

Update: Here’s a retort by Ryan Avent. Economists may say that the amount we spend on health care will be equilibrialized by the competitiveness of the international market. Job lock is awful, but my feeling is that it is peripheral to the argument. An employee exodus should make a firm more competitive, save for Darwin working his magic.

It’s still, and always will be, about the costs; required reading

More care, worse outcomes. Misaligned incentives. Complete ignorance of the macro view. Buckets of waste. Gaps in medical education. Lack of coordination and accountability. Solving health care locally.

In other words, Atul Gawande’s most recent dispatch in “The New Yorker” is, in my opinion, required reading. A snippet:

When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes.

Wrong-incentive health care

Health care pontificators like to talk about incentives. Who can blame them/us? Health care pays its players (or, all too often, doesn’t pay them) to do some funny things.

Today’s example is from The New York Times. Background info, “One in five Medicare patients, for example, returns to the hospital within 30 days. Over all, readmissions cost the federal government an estimated $17 billion a year.” Wrong-incentive health care:

Medical providers all too familiar with the financial double bind include Park Nicollet Health Services, a hospital and clinic system based in St. Louis Park, Minn. Park Nicollet started tackling the readmission problem four years ago, spending as much as $750,000 annually on more nurses and on sophisticated software to track heart failure patients after they left the hospital. It reduced readmissions for such patients to only 1 in 25, down from nearly 1 in 6.

But the reduction has been a losing proposition. Although the effort saved Medicare roughly $5 million a year, Park Nicollet is not paid to provide the follow-up care. Meanwhile, fewer returning hospital patients mean lower revenue for Park Nicollet.

44. The Levy Rule

A regularly linked-to (by this blog) health care CEO provides sage advice from previous non-profit work:

If a member of our Board proposed that we should do something, it became that person’s responsibility to get it done.

The rule may hinder idea formulation at the get-go. (Which may be a good thing; health care has plenty of ideas, the implementation part is where many hit the skids.) However, it will improve accountability (by proxy, execution) down the road. And because our culture is based upon participation, those keeping quiet on the necessary changes need no longer be a part of the team.

Harsh? Hopefully not. It has the ability to empower the change makers in the organization, to free them from the everyday barriers preventing progress in health care organizations.

Principle #44: Your suggestion, your responsibility.

Design and disruption

The Design Council Magazine hosted a virtual round table discussion addressing the relationships between design and business. A quote from service design specialist William Owen:

Design is integral if your business faces disruptions … in other words, if you’re in any kind of business.

43. Rethink

It’s not that a full-court press has never been used in the game of basketball (for it has, quite effectively); it’s where the thought to do so comes from. Coaching decisions to apply a full-court press originate because it has been, proven by the past (Digger Phelps, Rick Pitino), to be an effective way to disrupt the offensive team’s efforts. But in this case, as described by Malcolm Gladwell in The New Yorker, has been absolutely rethought:

(Vivek) Ranadivé was puzzled by the way Americans played basketball. He is from Mumbai. He grew up with cricket and soccer. He would never forget the first time he saw a basketball game. He thought it was mindless. Team A would score and then immediately retreat to its own end of the court. Team B would inbound the ball and dribble it into Team A’s end, where Team A was patiently waiting. Then the process would reverse itself. A basketball court was ninety-four feet long. But most of the time a team defended only about twenty-four feet of that, conceding the other seventy feet. Occasionally, teams would play a full-court press—that is, they would contest their opponent’s attempt to advance the ball up the court. But they would do it for only a few minutes at a time. It was as if there were a kind of conspiracy in the basketball world about the way the game ought to be played, and Ranadivé thought that that conspiracy had the effect of widening the gap between good teams and weak teams. Good teams, after all, had players who were tall and could dribble and shoot well; they could crisply execute their carefully prepared plays in their opponent’s end. Why, then, did weak teams play in a way that made it easy for good teams to do the very things that made them so good?

Lots of things have been rethought in health care. (e.g. Hospital gowns. Surgical checklists. Care delivery.) Welcomed by some, others not. There have been successes and failures. But a desire to improve the status quo is what drives these changes. There is plenty more to rethink: patient experience, care across the continuum, general hospital specialization, billing process, delivery models (again), reimbursement, facilitity design, communication…

To change is to rethink. To rethink is to improve.

Principle #43: Rethinking will be a daily activity at our own system. It drives our incessant desire to improve. The easiest way to rethink? Bring in outisders. The heart of diversity. Ranadivé rethought basketball using his experience from cricket and soccer to coach an “inferior” 12-year-old girls basketball team into a national championship game. Designers rethink with their design expertise. Engineers with engineering. Teachers with teaching. Young people with a lack of expertise. Experienced folks with an abundance. Encourage the dissent, embrace the noise. Etc.

Nourishing or Nauseating?

Looking inside a refrigerator can tell a lot about a person’s eating habits. Maybe an in-home refrigerator analysis is the key to eating healthier. Anyway, here’s a cool project by artist Mark Menjivar featured at Good. I expected a lot of refrigerators to look like the one below; not necessarily the case, though each refrigerator has an interesting story waiting to be told. It seems like a good idea for a community photo sharing effort. The contents could be analyzed by a community; (instead of hot or not) nourishing or nauseating?

But from the right vantage point, an open fridge is the perfect staging grounds for a discussion of consumption. And if the aphorism holds true—if we really are what we eat—then refrigerators are like windows into our souls. It’s that sentiment that’s at the heart of Mark Menjivar’s inventive exploration of hunger, “You Are What You Eat,” for which he photographed the contents of strangers’ refrigerators.

It’s (almost) all about women (or completely)

This book, according to TP (it’s been placed on my Amazon Wish List), says that women make 80 percent of the health care decisions. There really is no point in arguing the point; +/- 20 points and your service offering should still focus on helping women make decisions. This Department of Labor site claims the same statistic; it also says that women accounted for 60 percent of all expenses incurred at doctors’ offices in the fine year of 2004.

So when evidence starts to trickle out that men and women need different treatment for identical diagnoses, it’s no wonder that the health systems that “get it” are creating dedicated women’s health centers. It makes great sense.

The government even gets it. The U.S. Department of Health and Human Services has deemed twenty academic medical centers National Centers of Excellence in Women’s Health to “serve as demonstration models for the Nation to provide innovative, comprehensive and integrated health care systems for women.”